In the first two parts of this series, we discussed the different ways that fibromyalgia can affect libido and how to improve it. Another huge factor affecting sexual enjoyment in fibromyalgia is pain—both widespread pain and painful intercourse can wipe out any enjoyment of sex. To lessen overall fibromyalgia pain, the focus is on reducing inflammation, lessening pain triggers, along with specific pain-reducing treatments. You can learn more about my approach to reducing fibromyalgia pain in The FibroManual.

In this post I want to talk specifically about how to lessen pain experienced during sex. In fibromyalgia it can hurt to have pressure on the hips or weight on the body, and creativity may be required to find the most comfortable position. Taking a short-acting opiate pain medication just before sex can be helpful to reduce overall pain, but many of my patients find this can make achieving orgasms more difficult or less satisfying. Opiates use the same receptors in the brain as do the endorphins released during orgasm, so can blunt the orgasm experience.

However, cannabis (marijuana) derived treatments do not have these issues, and in fact are more often associated with increased sexual enjoyment. If using cannabis systemically is not an option for you, consider applying a topical cannabis (THC plus CBD) or a CBD-only balmto painful areas around hips and low back 30–60 minutes prior to sexual activity.

But what if the actual act of intercourse is physically painful? Pelvic soft-tissue pain with intercourse is really common in fibromyalgia. Sometimes this pain is due to muscle tension from excessive fight-or-flight nerve signals, so doing activities to activate a relaxation response like taking a hot bath, gentle stretching, deep breathing, or meditation can allow for softer muscles and less pain. Other times pelvic soft-tissue pain is due to myofascial restrictions and trigger points in the pelvic floor muscles, which frequently occur in fibromyalgia. Severe fascial adhesions and restrictions are often seen in women that have had multiple abdominal or pelvic surgeries or suffer from endometriosis.

In fibromyalgia a combination of muscle tension and myofascial restrictions both contribute to pain with intercourse. Targeted manual therapy such as myofascial release is the best way to gently break up those adhesions. In my personal experience, the John Barnes Myofascial Release Approach is the specific form of manual therapy that is most effective at reducing both overall fibromyalgia pain and painful intercourse.

Manual therapy for painful intercourse or pelvic pain often does involve internal vaginal and/or rectal work, so it is really important to find a therapist you trust. Sometimes intense emotions around past sexual traumas can come up during treatment as well. Releasing these stuck emotions is an important part of the healing process, and is yet another reason why feeling comfortable with your manual therapist is so key. To find a local provider in your area, visit www.mfrtherapists.com.

Several studies support the effectiveness of manual therapy directed at the pelvic fascia to reduce pain with intercourse:· One study reported this technique both reduced painful intercourse and increased orgasms: “Several of our patients volunteered the fact that they were having ‘the best sex, the best orgasms ever.’” (I will say this article was much more interesting than the usual dry scientific articles that I read!)· In a small study on manual physical therapy for pelvic floor dysfunction, 9 of 16 patients were able to return to pain-free intercourse after treatment with a combination of myofascial release, joint mobilization, muscle energy techniques, stretching, and neuromuscular reeducation.· 57% of those getting targeted myofascial release reported improvement in chronic pelvic pain compared to only 21% who received standard massage.

In addition to myofascial release therapy, one other important way to lessen painful intercourse is to ensure there is adequate vaginal moisture, which may mean using a sexual lubricant. There are CBD and cannabis infused lubricants that a few of my patients report lessened pain and increased pleasure with intercourse. For post-menopausal women, estrogen applied topically or vaginally can help to restore natural lubrication.

Since orgasms generate a huge release of natural pain-relieving endorphins and oxytocin, they can be a valuable contribution to our pain-management tool box in fibromyalgia. And orgasms help us remember that our body is not only a source of pain, but also a source of pleasure.